'When you hear hoofbeats, think of horses not zebras' - the old adage is well-known to GPs but what should you do when faced with a zebra, not a horse? Consultant cardiologist Professor Robert Tulloh and GP Dr Louise Tulloh kick off our new series with their advice on how to catch Kawasaki disease in general practice.

GPs urged to delay steroids until asthma diagnosis is confirmed

Fewer than one in five patients taking inhaled steroids for asthma has had the diagnosis confirmed by their GP with objective tests, research has

revealed.

The study leaders warned that many patients without a confirmed diagnosis may be taking inhaled steroids unnecessarily.

They urged GPs to delay long-term therapy until they had used objective lung function tests.

The retrospective analysis of the care of newly diagnosed asthma patients in 12 practices showed GPs tended to base their diagnosis on the patient's history. Just 14 per cent of children and 18 per cent of adults had diagnostic test results recorded in their notes.

Of the 161 children and 143 adults with asthma who were taking inhaled steroids, 41 per cent of children and 53 per cent of adults were prescribed inhaled steroids before or on the same day as the diagnosis was recorded.

Study co-author Dr Madge Vickers, head of the Medical Research Council's general practice research framework, said some GPs were starting patients on inhaled steroids too early.

She said: 'If inhaled corticosteroids are to be prescribed early there must be an improvement in the diagnosis of asthma in primary care, including the recording of results in the patient's notes.'

The findings ­ published in the latest issue of the Primary Care Respiratory Journal ­ highlight the work GPs face to meet the revised national asthma guidelines.

The guidelines, released this month, urge GPs to confirm an asthma diagnosis using objective tests ­ such as a 20 per cent or greater variation in peak

flow on at least three days per week over a two-week period.

Dr John Haughney, a GP in East Kilbride and chair of the diagnosis and natural history review group for the national asthma guidelines, said GPs must record how they made a diagnosis, even if it was based on history and symptoms alone.

He said: 'This study highlights the importance of making an objective diagnosis before committing to long-term treatment.'